Tracy Taris: The many faces of compulsion

Child & Family

“I’ve always known something was wrong. I just didn’t have a name for it until after I was 30. I’ve always washed my hands thoroughly, but I noticed other people didn’t take as long as I did,” said Liz Eager.

The anxiety in Santa Clarita resident Eager’s voice is apparent as she discusses her lifelong battle with Obsessive Compulsive Disorder (OCD).

OCD is an anxiety disorder. It consists of two components, an obsession, which is a thought that comes to mind that the person cannot control or get rid of and an action/behavior designed to alleviate the sense of anxiety.

Like Eager, some people may have OCD and not know it. Eager said once the odd behaviors she engaged in were defined for her she was relieved.

“I thought, ‘Oh my gosh! I’m not alone.’ I mean it wasn’t like I’d found a cure or anything. But I thought, ‘Now I can get help, there’s actually a name for this,’” she said.

Eager suffers from one of the seven most common types of OCD — washers and cleaners. Additional forms of OCD include:Checkers — people who check constantly to prevent something bad from happening (i.e. “did I turn off the stove?” “lock the door?” “unplug the curling iron?”). A checker can get caught up in hours of checking and doubting the same thing over and over.

Repeaters — people who have a thought that something will happen and will repeat the same action over and over to prevent the thought from coming true.

An example of a repeater would be a wife who prevents her husband from dying by tying and untying her shoes until the thoughts of him dying dissipate.

Orders — people whose functioning is disrupted if things aren’t symmetrically arranged in a certain way.

They use inordinate amounts of time making sure things are aligned in specific patterns and become extremely upset when something has been moved.

To resume some semblance of functioning they have to align things the way they were.

Hoarders — people who can’t get rid of or throw away non-essential things. In a hoarder’s mind, everything is essential and they fear letting go because they “might” need the item later. Hoarders believe that if the need arises and the item has been discarded, they may die or have some other terrible thing happen.

Thinking ritualizers — This person has repetitive thoughts to counteract an anxiety-provoking thought.

The thinking ritualizer has an obsessive thought that is followed by the compulsion which is also a thought, not a behavior. Mentally repeating the same words over and over, counting, or associating certain numbers to good or bad luck are common rituals.

Worriers and pure obsessionals — people who fall under this cluster also do not experience repetitious behavior nor do they experience thinking compulsions. They worry about health problems, past events or future failures.

An example would be someone who worries that they’ll loose their job and subsequently their home and then constantly dwell on how the thought of loosing their job may end up coming true.

The subtype washers and cleaners are people who worry about contamination from things like germs, disease or bodily secretions.

To alleviate the fear of contamination, the person will develop rituals of washing their hands over and over, taking extremely long showers, or cleaning.

Some spend entire days cleaning an already spotless home.

The person suffering from this subtype spends exorbitant amounts of time engaging in the rituals to prevent death and/or illness that they think is inevitable.

All abnormal behavior is normal behavior that is taken to extreme. It prevents a person from working or carrying out normal, daily activities. For example, most people want clean hands, but most people will not wash their hands longer than a few seconds at a time. If the amount of time spent interferes with or impairs the person’s ability to function normally, as it does in Eager’s case, treatment is needed.

“I hate it. It’s like I’m in a prison and I just want to be free from it and not worry all the time, are my hands clean, is this dirty, is that dirty? I just want to be free from the obsessions in my head,” said Eager.

Eager can easily spend up to 30 minutes at a time, several times a day, washing her hands. She can spend up to three hours in the shower at a time.

There are several types of treatment for OCD but the most effective and most commonly used by mental health professionals are behavioral and medication treatments.

The cause of OCD is not yet known but brain scans implicate a biological basis. Imaging techniques have shown that abnormalities in the brain’s frontal lobe and basal ganglia may cause the illness.

Other studies point to a deficiency of certain neurotransmitters, (like serotonin), that regulate mood, aggression and impulsivity.

Nonbiological explanations of OCD suggest an interaction between behavior, environment, beliefs, attitudes and how a person processes information.

OCD is often missed because it can overlap with other mental disorders like depression, Asperger’s, attention deficit hyperactivity disorder and eating disorders.

Nicole Hoffman, a psychologist with the Child & Family Center, said OCD can often appear to be oppositional defiant disorder (ODD) in children.

“The symptoms can look like ODD because the child is so agitated he feels like he’s going to crawl out of his skin. Since he can’t communicate what’s going on, the anxiety appears to be oppositional behavior because the child doesn’t have words or tools to communicate what he is feeling inside,” said Hoffman.

Hoffman believes in exploring what is underneath the behavior.

“The child usually has an underlying fear or a worry that their life will be affected in some negative way,” she said. “Therefore if they have the thought, they’re committed to acting on the compulsion in order to relieve their experienced anxiety or fear so they can’t stop themselves.

“For example, if the child has a fear that his or her parents will die if they do not perform a certain compulsion, they believe that if they don’t act on the obsession, their parents will die. This creates a cycle because when they do commit the compulsion and no one dies, they believe no one died because they acted on the compulsion.”

An effective cognitive behavioral treatment for OCD clients is Exposure and Response Prevention which is a therapy that addresses the short-term avoidance the person with OCD engages in.

It teaches the person to sit with their obsessions without engaging in the compulsion to give the anxiety a chance to relieve itself.

Allowing time to pass between the onset of the obsession and acting on the compulsion will increase the person’s belief that the thing they fear will happen, won’t.

In Hoffman’s work, she teaches the client to tolerate the anxiety in small ways at first.

“If a client wants to wash his hands in the middle of a session, I might ask him to wait three to five minutes instead of letting him give in immediately to the compulsion of washing his hands. The idea is to stretch that time out in small increments to build tolerance for sitting with the thought without acting on it right away,” she said.

Hoffman also facilitates learning in her clients by helping the client change the way he or she profess their anxiety.

For instance, if a client states that he or she cannot open a door unless he or she has a tissue to turn the doorknob, she will state simply in a nonthreatening manner: “Yes, you can open the door without using a tissue to turn the knob, you just think you can not open the door because of your experienced anxiety or fears.”

Hoffman believes strongly that though you can’t change how a child feels, you can change his or her vocabulary, which is a step toward helping the child alter their view and way of thinking.

OCD is not something that can be diagnosed for a loved one who “seemingly” obsesses about having clean hands or having things arranged a certain way. It is a disease that has to be assessed and treated by a professional.

A therapist can teach the sufferer self-regulation skills, find out what triggers the anxiety, what kind of compulsions are involved, assess the function of the compulsion or ritual and decide on the best way to treat an individual.

Eager is in the process of getting treatment, and has high hopes she can recover from what she describes as “a mental sensation where you can’t be at peace no matter what you do.”

She said she hopes to finally acquire tools to assuage her anxiety, so she doesn’t have to spend so much time relying on her rituals to calm her fearful thoughts.

Tracy Taris is a Full Service Partnership (FSP) staff therapist and an MFT intern at the Santa Clarita Valley Child & Family Center. She received her Masters Degree in Clinical Psychology from Azusa Pacific University. For more information about the SCV Child & Family Center call (661) 259-9439 or visit childfamilycenter.org.